Obesity is the major risk factor for many chronic diseases such as diabetes, hypertension, cardiovascular diseases, and cancer. Obesity has a negative impact on the immune systems. Obesity is associated with chronic low-grade inflammation and altered immune functions. The regulation of body weight is by the interplay of many neuronal circuitries in the brain that control the food intake and energy expenditure. There is a link between the central nervous system (CNS) and immune system. Therefore, in the present review article, we have discussed the immunomodulation in obesity and its interactions with the CNS.

Alteration of autonomic function is associated with disease severity in patients with bronchial asthma

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Alakh Ram Verma, PK KhodiarDOI:10.4103/2348-8093.161535

Background and Aim: Abnormality in the autonomic regulation of the airway results in airway obstruction in bronchial asthma. However, autonomic abnormality in asthmatic patients is generalized and is not confined to airway only. Therefore, the present study was conducted to assess the abnormality of autonomic nervous system (ANS) and its association with disease severity in bronchial asthma patients.
Methods: Sixty patients of bronchial asthma aged between 15 and 50 years were included in the study. After taking informed consent, the duration of asthma was noted in each of these patients and six noninvasive ANS testing namely deep breathing test, orthostatic test, 30:15 ratio, sustained hand grip test, valsalva manoeuvre and cold pressure test was performed.
Results: The study population consisted of 60 bronchial asthma patients (34 males and 26 females) and 60 controls (32 males and 28 females). It was found that out of 60 patients, 46 patients had abnormal autonomic function test values (P < 0.001). Patients who depicted more than one abnormal autonomic function test, had bronchial asthma for more than 5 years. Similarly, 32 patients having severe asthma and 28 patients having moderate asthma showed evidence of autonomic dysfunction (P < 0.001). About 48% patients had only parasympathetic dysfunction.
Conclusion: Bronchial asthma patients displayed definitive dysfunction of ANS as compared with age and sex-matched controls. With severity and chronicity of asthma, the autonomic function was proportionately attenuated. Parasympathetic overactivity appears to be closely linked to the severity of bronchial asthma.

Background and Aim: The interpretation of the electrocardiographic deflection in terms of mean QRS axis (MQRSA) direction and deviation constitutes one of the most important diagnostic aids for the accurate and deductive evaluation of the electrocardiogram. This study was undertaken to assess the MQRSA in an Indian sub-population free of any cardiac illness using the hexaxial reference system and a formula tan θ = (I + 2III)/√3 I.
Methods: The present work is a hospital based cross-sectional study. After getting consent, data was collected from 162 subjects (91 males and 71 females). Electrocardiogram of the subjects studied were taken using Marquette 2000 portable electrocardiographs. Chi-square test was used for comparision of data between the two methods.
Results: MQRSA of 162 adult subjects with no any past or present history of cardiac illness was found to be directed within a narrow range between +40° and +60°. Hundred and forty-two had their mean electrical axis between 0° and +90° and 18 had their mean electrical axis between −90° and 0°. Of the 104 subjects >50 years, 16 (15%) have a statistically significant left axis deviation. The results obtained by both the graph and formula methods tallied perfectly.
Conclusion: This investigation confirms that a majority of the subjects had their MQRSA lying in the range 0°-90°, which is the accepted normal range. The formula can be reliably used for a bedside axis calculation.

Background and Aim: Diabetes mellitus is an endocrine disorder characterized by metabolic abnormalities, which has been reported to be associated with cognitive dysfunctions. Exercise along with diet and medication has been considered as a cornerstone in the management of type 2 diabetes mellitus (T2DM). Therefore, the present study was undertaken to study the effect of 2 months of structured exercise therapy on executive functions of the brain in freshly diagnosed patients with T2DM.
Methods: Sixty newly diagnosed patients with type 2 diabetes and Thirty age, sex and mean education matched matched healthy controls were enrolled as study participants in this interventional randomized controlled trial. The 60 T2DM patients were divided randomly into two groups as diabetic control (patients only on dietary and medication) and interventional group (IG) (patients on structured exercise therapy along with diet and medication). Body mass index (BMI), glycated hemoglobin (HbA1c) and executive functions (Stroop test) were assessed in these subjects before and after exercise therapy.
Results: Findings showed improvement in executive functions after administration of structured exercise therapy. BMI and HbA1c values have also improved at the end of 2 months in the IG and a significant correlation was observed between BMI, and executive functions.
Conclusion: Exercise therapy along with dietary control and anti-diabetic medication has an affirmative influence on executive functions of the brain.

Background and Aim: Prediabetes is reported to be associated with the cardiovascular morbidity and mortality in Indian population. This study was conducted to screen out prediabetes (impaired fasting glycemia and impaired glucose tolerance [IGT]) and to assess white blood cell (WBC) counts as a risk factor for future cardiovascular complications.
Methods: A total of 200 nondiabetic apparently healthy subjects were selected for the study. Estimation of plasma glucose (PG) levels by GOD-POD method and oral glucose tolerance test (GTT) was performed in all the subjects. Based on PG and GTT values, these subjects were divided into four groups, Group I: Normal fasting glucose/normal glucose tolerance (NFG/NGT, n = 70), Group II: Isolated Impaired fasting Glucose (iIFG, n = 34), Group III: Isolated IGT (iIGT, n = 38) and Group IV: Impaired fasting glucose and IGT (IFG/IGT, n = 54). WBC counts were estimated in all the subjects and were compared among the groups. Association of WBC with body mass index, systolic blood pressure (SBP), 2 hour post-challenge glucose levels (2 h PG) and rate pressure product was done using correlation analysis.
Results: The iIGT and IFG/IGT group had a significantly higher WBC count compared to subjects with NFG/NGT and iIFG group (P < 0.05). However, the WBC counts between the iIGT and IFG/IGT groups were comparable (P > 0.05). WBC counts were significantly associated with rate pressure product in all prediabetic subjects and with SBP and 2 h PG in subjects with IGT. Bivariate regression analysis showed association of WBC with rate pressure product (RPP) a known cardiovascular risk factor in prediabetics after adjusting other parameters.
Conclusion: This suggested that WBC count increase with raised 2 h PG in subjects with iIGT, and could be associated with metabolic syndrome and insulin resistance. Increased WBC counts and RPP in subjects with IGT, increases the cardiac risk burden in these subjects compared to subjects with IFG.

Background and Aim: Chronic cigarette smoking affects the normal hemostasis by influencing the coagulation pathways. However, the effect of smoking intensity on the degree of impairment of coagulation cascade still remains unclear. The present study was undertaken to assess the impact of smoking on the coagulation cascade and to study the association of smoking duration with coagulation defects.
Methods: A total of 120 apparently healthy subjects were enrolled for our study, were subsequently divided into 60 chronic smokers and 60 nonsmokers. The smokers group was further divided into group-1 (5-15 pack years) and group-2 (>15 pack years) depending on the duration of smoking. All the subjects were evaluated for complete hemogram, platelet count, mean platelet volume, prothrombin time, activated partial thromboplastin time (APTT), and platelet aggregation.
Results: The platelet count was significantly (P < 0.05) lower, APTT was significantly shorter (P < 0.001) and platelet aggregability was significantly higher (P < 0.05) in smokers. Smokers with >15 pack years of duration had significantly high platelet aggregation and shorter APTT compared to smokers with 5-15 pack years. Pearson correlation analysis suggested a strong negative correlation between platelet count and APTT with duration of smoking (r = −0.557 and r = −0.342, respectively).
Conclusion: Chronic smokers tend to have lower platelet count, shorter APTT, and higher platelet aggregability compared to non-smokers. Therefore, chronic smokers should be investigated for hemostatic dysfunctions.

The link of sympathovagal imbalance (SVI) to rate-pressure product (RPP), the marker of myocardial stress in prehypertension has not been elucidated. Body mass index (BMI), cardiovascular parameters, spectral analysis of heart rate variability, and RPP were assessed in young normotensives (n = 58) and prehypertensives (n = 58). BMI, heart rate, blood pressure, RPP and low-frequency to high-frequency (LF-HF) ratio were more in prehypertensives compared to normotensives. Pearson correlation revealed a significant association of LF-HF with RPP in prehypertensives, but not in normotensives. Bivariate regression analysis revealed the independent contribution of LF-HF ratio to RPP in prehypertensives. It was concluded that SVI contributed to myocardial work stress in young prehypertensives.

Roundworm infestation is common in the human intestine. Sometimes it also enters the biliary system and may cause acute cholangitis, obstructive jaundice, stone formation, acute biliary colic and cholecystitis. Rarely, ascariasis of common bile duct (CBD) can result after endoscopic retrograde cholangiopancreatogram (ERCP) done for CBD stone extraction. We present one such unusual case of roundworm in CBD stent in the post-ERCP period.

Penile fracture remains a rare, yet likely underreported condition. Fracture of the penis is a tear in the tunica albuginea of the corpora cavernosa that may be associated with injury to the corpus spongiosum and urethra. Diagnosis is usually clinical, and urethral injury should be suspected in the penile fracture, especially in those cases with bilateral cavernosal rupture. The usual cause is abrupt bending of the erect penis by blunt trauma most commonly during sexual intercourse. A crackling sound, pain, detumescence, bruising, swelling, and bleeding per urethra are the common symptoms reported by the patients. Early surgical management is the treatment of choice with a low incidence of complications. We report a case of fracture penis in a 35-year-old male came to the emergency out-patient department of our hospital.